Name: Dr M G Bhat Designation: Consultant Surgeon ... · • Bariatric surgery should be considered part of the treatment in PCOS women, especially in those with MS. Defining the

Name: Dr M G Bhat

Designation: Consultant Surgeon

Affiliation: Manipal & Apollo Spectra Hospital

Special Interest:Laparoscopy & Bariatric Surgery

When should we suggest Bariatric Surgery

in PCOD ?

17 June 2017 [email protected] 2


Epidemiology of obesity 1,2,3


• Billion Adults are overweight

• 312 Million are obese

• 3-4 Million die each year due to overweight and obesity

• Diabetes, IHD, Cancers

• 60% of women are overweight (≥25 kg/m2) US & Europe

• 30% of these are obese (≥30 kg/m2)

• 6% of these are morbidly obese (≥35 kg/m2)

1. Preventing and managing the global epidemic on Obesity WHO Report , 1997.

2. Obesity. Lancet 2005; 366: 1197-209.Haslam DW, James WP.

3. Improving reproductive performance in overweight/obese women with effective weight

management. Norman RJ, Noakes M, Wu R, Davies MJ, Moran L, Wang JX.

Hum Reprod Update 2004; 10:267-80.


• The incidence of obesity is gradually

increasing in India.

• 10-40% of urban population - Obese

• Punjab 40%.

• Karnataka 14%.

• 3rd Obese Nation in the World


The impact of obesity on reproduction in women with polycystic ovary syndrome. Pasquali R et all: BJOG 2006; 113:1148–1159. ( Review Article)

Obesity and Women


• Obesity in infertile women is high

• 30-70% of PCOS are Obese

• Menstrual irregularities & infertility

• Risks in Pregnancy are increased

• Poor reproductive outcomes • conceptions-in Both natural and

assisted

• Weight Loss has beneficial effects


Underweight - <18

Normal - 18 -25

Overweight - >25

Obese - > 30

Morbidly Obese->40

Super Obese-> 50

Measurement of Obesity

8

Body Weight in Kg

(Height in m)2=

Kg

m2


The Reasons for Obesity

• Life Style Issue

• Eating more than required

• The weight gradually increases!


MENSTRUAL DISORDERS

INFERTILITY

HYPERANDROGENISM

METABOLIC SYNDROME


Obesity and PCOS From: Pasquali R et all: BJOG 2006; 113:1148–1159


Prevent .. obesity?

• Weight Conscious

• Calorie Conscious

• Continuous Effort

Diet & …Exercise


Bariatric Procedures


Surgery for Obesity (Bariatric Surgery or Wt Loss Surgery )

• Surgery to Reduce Food Intake or Decrease Absorption or Both

• It is not Fat Reducing Surgery.

• Loss of weight is gradual

• Diet Control is Essential and All Life


When to Suggest Surgery ?

• Obese: BMI of >30

• BMI of >25 with one or more obesity Related Health Conditions

• Others (failed attempts, psychological etc)


Laparoscopic Gastric Sleeve Resection

• Remove 80% Stomach• Tube or Sleeve Like

Stomach is left behind

• 70% Excess Weight Loss in 18 months

• Type 2 Diabetes Resolution in 70 - 80%

• Improves all other Co Morbidities



INSERT GASTRIC SLEEVE VIDEO


Intra Gastric Balloon

• Reduced Capacity

•

• Stomach Full

• Short Term / Temporary

• About 10-15kg Loss

• 3-6 months


• Medical Problems• Physical• Social • Psychological• Economical


PCOS / Weight Loss / Pregnancy From: Pasquali R et all: BJOG 2006; 113:1148–1159


• (n = 17) of PCOS patients with an average age of 30 years were followed

prospectively 26 months after bariatric surgery.

• (12/17) regained normal menstrual function and (10/12) had documented

spontaneous ovulation. .

• Follow up for more than 2 years showed that all women resumed normal

menstrual cycles, HbA1C decreased from 8.2% to 5.1% in < 3 months.

• 78% saw improvement in metabolic syndrome & 48% showed

improvement in PCOS

Role of Bariatric Surgery in PCOS

Clin Endocriol Metab: 2005 Dec;90(12):6364-9. Escobar et all ( from Spain) The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery.


• Bariatric surgery can be effective in achieving significant

weight loss, restoration of the hypothalamic pituitary

axis, reduction of cardiovascular risk and even in

improving pregnancy outcomes.

• Bariatric surgery should be considered part of the

treatment in PCOS women, especially in those with MS.

Defining the role of Bariatric Surgery in PCOS Patients

Shaveta M Malik and Michael L Traub.

World J Diabetes. 2012 April 15;3(4):71-79

(published online 10.4239/wjd.v3.i4.71) USA


• Transmission of obesity to offspring was reduced by 50%

• The risk of fetal macrosomia was reduced

Large Maternal Weight Loss from Obesity Surgery Prevents transmission of Obesity to children who were followed for 2-18 yrs. Pediatrics - 20016 Dec;118(6):e 1644-9. Kral JG et all (USA)


12 months (1 year)

after bariatric surgery

Before becoming pregnant in order to

allow the rapid weight loss and metabolic

changes to subside.

THE SAFE TIMING OF PREGNANCY


Type 2 Diabetes 95%

Sleep Apnea75%

Osteoarthritis82%

Cardiac Function Improvement

97%

Hypertension97%

Stress Incontinence87%

MenstrualIrregularity

50%

Reflux Disease98%

Depression80%

Hyperlipidemia60%

Obesity Related Co-Morbidities


Analysis of 114 Sleeve Resections2009-2017

• All except 3 have maintained weight loss • 97/114 Women• 20/97 were 23-35 years age• 4 became pregnant and have live children • 6 highly Diabetic Patients are without Insulin

• Shows Obesity is a Metabolic Disorder and thus Metabolic Surgery and Diabesity are coined


• PCOS is highly prevalent and strongly associated with obesity and MS.

• PCOS develop coronary artery disease and Glucose abnormalities at a

very young age and are therefore at risk for life threatening cardiac

events.

• Bariatric surgery is a powerful tool that should not be overlooked simply

because a woman is young or presents with PCOS and MS.

• Every woman with PCOS , MS and Obesity should be offered

education and counseling regarding weight loss to reduce their

illness.

• Bariatric surgery should be considered along with other medical and

lifestyle alterations as first line therapy in PCOS women with obesity

and MS.

In Summary…


Bariatric Surgery has a definite role in young womenWith PCOS

1. BMI >30 2. Failed Life Style Changes3. BMI>25 with Co Morbid Conditions

Literature Review confirms that weight reduction regulate hormones, improve ovulation and pregnancy rate

In Summary…

Consultant SurgeonLaparoscopy and Bariatric Surgery Manipal HospitalApollo Spectra Hospital, KoramangalaBangalore, India

Thank you…

Dr. M G BhatMS, FRCS(England & Edinburgh), FICS, DMLE (Law), DMIRCSEd (Informatics)


www.bariatricsurgerybangalore.comwww.drmgbhat.com

Documents

Name: Dr M G Bhat Designation: Consultant Surgeon ... · • Bariatric surgery should be considered part of the treatment in PCOS women, especially in those with MS. Defining the